Does your little one have a hole in their heart? Let's learn about Ventricular Septal Defect (VSD) without fear!

When your little one was born, did the doctor say something like, "Hmm, there's a little heart murmur" when he checked his heart? Or did you feel like your baby was having trouble breathing or sweating when he was breastfeeding or running around? Sometimes, the cause of these things can be a small hole in the heart. In medicine, we call this a `(Ventricular Septal Defect)` or `VSD` . So today, we're going to talk about this in detail and very simply. There's no need to be afraid, because the most important thing is to be aware of this.

What is VSD? What exactly happens?

Simply put, a VSD is a hole in the wall (called the septum) between the two main chambers (called the ventricles) of our heart. Think of it like a small house with four rooms. There are walls between these rooms to keep blood from mixing with each other. "Good blood" with more oxygen flows on one side, and "bad blood" with less oxygen flows on the other.

Now, what happens if this is a `VSD`, that is, if there is a hole in the wall between those two lower chambers? The blood that has more oxygen leaks through the hole into the blood that has less oxygen. Then the heart and lungs have to work a little harder. This condition is one of the most common congenital heart diseases . Sometimes this `VSD` can occur together with other heart diseases.

Remember, not all VSDs are dangerous. In most cases, small holes close on their own without any symptoms.

Are there types of VSD?

Yes, there are four main types of VSD, depending on where it occurs and the nature of the hole. Let's see what they are:

• Membranous VSD: This is the most common type. The hole occurs in the upper part of the wall between the two lower chambers of the heart.
• Muscular VSD: In this type, the hole occurs in the lower, muscular part of the wall. Sometimes, there can be more than one hole in this type of VSD.
• Inlet VSD: This hole is located just below the tricuspid valve in the right ventricle of the heart and the mitral valve in the left ventricle. Specifically, close to where blood enters the ventricles.
• Outlet VSD: In this case, the hole is located near the pulmonary valve, which carries blood from the right ventricle to the lungs, and the aortic valve, which carries blood from the left ventricle to the body. This means that blood has to pass through this VSD when it leaves the ventricles.

If a doctor says your baby has a VSD, they will also explain what type it is.

What are the symptoms of a VSD? Are they different for children and adults?

The symptoms of a VSD depend on the size of the hole. A very small hole (less than 3 millimeters, about the size of a toothpick) may not cause any symptoms. However, if the hole is a little larger (medium-sized, 3-5 millimeters, or large, 6-10 millimeters, about the size of a pea), symptoms may occur.

Symptoms in newborn babies

If a newborn baby has a large VSD, it may have symptoms similar to heart failure . These include:

• Difficulty breathing: Things like rapid breathing, struggling to breathe.
• Sweating or feeling tired when breastfeeding: The baby may feel tired even after drinking a little milk.
• Lack of weight gain: If the baby is not gaining weight appropriately for their age.
• Frequent respiratory infections: If you get colds and coughs frequently.

Symptoms in older children and adults

If an older child or adult has a VSD, they may feel tired or short of breath during physical activity . If they tire easily while playing, running, or jumping, you should be concerned.

Does the size of the hole also affect it?

Yes, absolutely. As mentioned earlier, if the hole is small, there may be no problem. But as the hole gets larger, blood leaks between the two chambers of the heart. That's when symptoms appear.

Why does this VSD occur? What are the causes?

The exact cause of a VSD is not yet known . It most often occurs when the heart does not develop properly while the baby is growing in the womb. That is, the wall between the chambers of the heart does not close completely.

However, sometimes VSD can occur together with other congenital conditions. For example, children with genetic conditions such as Down syndrome are more likely to develop VSD.

Very rarely, a heart attack in an adult can cause damage to the wall between the heart's cells and cause a new VSD to form. This is very rare.

Who is at higher risk of developing VSD?

Some factors have been found to slightly increase the risk of developing a VSD:

• Premature babies: Babies born before the due date.
• Some genetic conditions: As mentioned earlier, conditions such as ``Down syndrome''.
• Some medications taken during pregnancy: Medications such as valproic acid and phenytoin, which are used to treat seizures.
• Drinking alcohol during pregnancy: This is also suspected to be a risk, but further research is needed.

These are only risk factors, and it cannot be said that VSD will develop just because these things are present.

What are the possible complications of a VSD? Are these dangerous?

When blood leaks through a VSD, it becomes difficult for your baby's heart to work efficiently. If the hole is large, the heart has to work harder. When the heart works this hard for a long time, various problems can occur in the heart and lungs. These can sometimes be serious .

Because the pressure in the two chambers of the heart is different, more blood can flow to the lungs. This can lead to serious conditions such as pulmonary hypertension . If a medium or large VSD is not treated within 2 years , it can lead to a condition called Eisenmenger syndrome . This can cause permanent damage to the blood vessels in the lungs.

Other complications may include:

• Heart failure
• Aortic regurgitation
• Enlarged ventricles
• Infection of the inner lining of the heart (Endocarditis)
• Abnormal heart rhythm
• Stroke

This is why it is important to seek the advice of a doctor as soon as you find out you have a VSD.

How do doctors diagnose a VSD?

A doctor will diagnose a VSD based on your baby's symptoms, a physical exam, and some special tests. If the hole is very small, it may not be possible to detect a VSD because there are no symptoms.

A VSD is often discovered during a physical exam . When a doctor listens to a baby's heart with a stethoscope, a heart murmur is heard if a VSD is present. This sound can give a rough idea of ​​the size of the hole.

There are several tests that can show changes in the heart's structure, heartbeat, and blood flow due to a VSD:

• Echocardiogram: This is the most important test. It's like an ultrasound scan of the heart. It can show the size of the hole, its location, and how much blood is leaking.
• Electrocardiogram (EKG): A test that looks at the electrical activity of the heart.
• Chest X-ray: This can be used to see if the heart is enlarged or if there is too much blood in the lungs.
• Cardiac CT scan
• Cardiac MRI `(Cardiac MRI)`
• Cardiac catheterization: This involves passing a small tube through a blood vessel into the heart to measure pressure and take samples.

How do you treat a child with a VSD?

Most VSDs are very small and do not cause any problems. In such cases, the doctor will monitor the symptoms and see if the hole closes on its own. In most cases , these small holes close on their own by the age of 6.. In some cases, it can take longer. But after 20 years, it is less likely that a `VSD` will close on its own.

If you have a medium or large VSD, your doctor will likely recommend surgery or another procedure to close the hole . In the meantime, you may be given medication to control your symptoms.

The important thing is that if a large VSD is repaired before the age of 2, it can prevent damage to the baby's heart and lungs. Otherwise, the damage can become permanent and worsen over time.

Medicines

To control symptoms before surgery, or if the hole is expected to close on its own, your doctor may prescribe medications such as:

• Diuretics: These work by reducing the extra fluid that builds up around the baby's heart.
• Heart failure medications: These control the speed and strength of the baby's heartbeat.

Surgeries or other procedures

There are two main ways to fix a `VSD`:

• Surgery: A heart surgeon closes the hole. The hole may be sewn shut, or a patch made from a synthetic material or the baby's own tissue may be applied.
• Transcatheter procedures: This does not involve surgery. A small tube (catheter) is passed through a large blood vessel in the leg or arm to the heart, and a special device is inserted through it to close the hole.

In both of these methods, over time, the baby's heart tissue grows around the patch or device, becoming part of the heart wall itself.

The recovery time after a VSD repair depends on the method used. Transcatheter methods can take a few days to a few weeks to heal. Surgery can take a few weeks or months. In most cases, VSD symptoms will subside after these treatments.

What time should I see a doctor?

If you or your baby has a VSD, be aware of the common symptoms of a VSD, as well as any sudden changes or unusual symptoms. In general, if you or your baby have difficulty breathing, or if the skin, lips, or fingernails turn blue/pale (this is called cyanosis), you should go to the hospital immediately.

Talk to your baby's doctor if you notice any of these symptoms:

• Weight gain slower than expected.
• Sweating or straining while breastfeeding.
• Constant restlessness, difficulty breathing.
• Frequent respiratory infections.

If you have a VSD as an adult, talk to your doctor about these things:

• If you get tired easily or become short of breath during physical activity.
• If you are constantly pale, or if you notice your fingertips or lips turning blue.

Also, if you have a VSD, you should tell your doctor before having any other surgery or dental treatment.

What are the important questions to ask the doctor?

You can ask your baby's doctor these questions:

• How big is my baby's Ventricular Septal Defect?
• What kind of treatment do you recommend?
• Do I need extra calories to help my baby gain weight quickly?
• How often does my baby need to come for follow-up appointments?

In addition to these questions, don't be afraid to ask anything you can think of.

What can you expect when living with a VSD? What can parents do to help their little one?

In the case of a medium or large VSD, repairing the hole is usually enough to prevent complications. Very rarely, if new bleeding occurs around the repair, reoperation may be necessary.

Most adults living with a VSD don't even know they have it, because it's small enough to cause no problems. But if the VSD is large (especially if it's not repaired), it can affect your lifestyle. If an adult has a VSD, it can last a lifetime unless it's repaired.

Most people with a VSD live a normal life span, just like someone without one. This is especially true if the VSD is small and closes spontaneously.

However, people with a medium or large VSD (whether treated or not) may have a slightly shorter life expectancy, especially if the VSD is not corrected early. If a condition such as Eisenmenger syndrome develops, life expectancy may be reduced.

Things you can do as a parent:

• If your baby has symptoms of a VSD, the doctor will likely advise him to rest and avoid strenuous physical activity . Especially if he has Eisenmenger syndrome, he should not do anything that puts too much strain on the heart.
• Take your medication exactly as prescribed by your doctor. Do not change or stop your medication without your doctor's advice.
• It's normal to feel anxious and scared when you find out that your baby has a Ventricular Septal Defect. If you're feeling this way, it's a good idea to talk to your baby's doctor. That way, you can get a better understanding of the condition and what to expect. Your doctor can also help you understand how to treat the condition, prevent complications, and minimize the impact it has on your baby's life.

Take-Home Message:

Okay, so we've talked a lot about `VSD`. Remember this too:

• A `VSD` is a hole in the wall between the two lower chambers of the heart.
• Very small VSDs close on their own without any symptoms.
• Large VSDs can cause symptoms, especially in young babies, such as fatigue and difficulty breathing while breastfeeding.
• If you suspect you have a VSD, it is important to see a doctor and have a test such as an echocardiogram.
• There are surgical or transcatheter procedures available for treating large VSDs. These can produce very good results.
• The most important thing is to diagnose the disease early and get the necessary treatment. This can go a long way in preventing serious complications.

If you have any further questions about this, don't hesitate to ask your doctor. Stay healthy!

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